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National Glaucoma Research Report: Winter 2019

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In This Issue...

Top Five Questions Asked About Glaucoma

Ophthalmologist Dr. Yvonne Ou answers patients’ most common questions

Yvonne Ou, MD, an ophthalmologist at the University of California, San Francisco, UCSF Medical Center answers some of the most common questions patients have about glaucoma.

QUESTION 1: Do I have glaucoma?
Dr. Ou: Some cases of glaucoma are clear-cut, others are not. For example, the optic nerves of individuals with myopia (nearsightedness) may suggest glaucoma, but doctors will categorize them as “glaucoma suspect” at first. It’s important for these patients to be monitored with regular exams to see if their optic nerves change over time.

QUESTION 2: Will I go blind?
Glaucoma could potentially cause irreversible blindness. The more damaged the optic nerve is at the time of diagnosis, the more advanced the glaucoma and the higher the risk of losing vision. Patients who seek follow-up care and adhere to treatments prescribed by their doctor decrease their risk of going blind.

QUESTION 3: What is my eye pressure?
Eye pressure is one of several important measurements your ophthalmologist will assess. It’s important to know that eye pressure can vary because of many factors, such as time of day, corneal thickness, or even stress.

QUESTION 4: Is my glaucoma stable?
Your ophthalmologist will determine whether your glaucoma is stable using several assessments including: an eye exam, looking at and measuring your optic nerves, measuring eye pressure, and visual field tests.

QUESTION 5: Can lifestyle changes improve my glaucoma?
There is no clinically proven lifestyle modification that improves glaucoma. However, general advice about improving your overall health applies: eat a healthy diet, use alcohol and caffeine in moderation, maintain a healthy weight, exercise, and don’t smoke. Some evidence suggests eating green leafy vegetables decreases the risk of developing glaucoma. There are no clinically proven vitamin supplements that will improve or even slow glaucoma.

President’s Corner

I’m so grateful donors like you believe so strongly in our mission. Your generosity has made National Glaucoma Research the largest private funder of glaucoma research in the world, creating the most promising research pipeline to a cure. Because of your support, we are able to fund the most innovative research studies and have been able to facilitate the first global forum where scientists could connect and exchange ideas, data, and results. Thanks to you, National Glaucoma Research is creating new opportunities for collaboration and discovery.

It’s so energizing to hear the enthusiasm of National Glaucoma Research grantees as we discuss the progress of their research. They are sincerely grateful to have the opportunity and support they need to address glaucoma from new angles and with fresh approaches. Like Dr. Meredith Gregory-Ksander, whom you’ll read about in this issue of National Glaucoma Research Report, these scientists are excited and hopeful that their work will yield much needed new insights into this disease. And, that new treatment options for patients won’t be far behind.

Thank you again for partnering with us to help stop glaucoma from stealing the precious gift of sight from millions of people!

Stacy Pagos Haller
President

Spotlight On ... Meredith Gregory-Ksander, PhD

 

A New Method to Inhibit Inflammation and Prevent Glaucoma

National Glaucoma Research grantee Dr. Meredith Gregory-Ksander is targeting inflammation to develop new avenues for treating glaucoma. Inflammation is the body’s response to fight infections or heal after injury in many parts of the body. But, in the eye, inflammation is tightly regulated and helps not only to protect and heal the eye, but also preserve delicate tissues, such as the retina and optic nerve that are critical for vision. Dr. Gregory-Ksander has determined that in glaucoma with age, these regulations on inflammation have been disrupted, and now this inflammation in the eye has become destructive.

Dr. Gregory-Ksander has identified a pathway that mediates this inflammation, particularly in glaucoma. Receiving a National Glaucoma Research grant offers an opportunity to determine what kind of pivotal role inflammation plays in the development of glaucoma. This exciting new focus may help identify new treatments that can directly protect the retinal ganglion cells and the optic nerve that is damaged in glaucoma. Understanding how these cells are being killed could lead to a therapy that will treat, potentially, all patients, whether they have normal or elevated eye pressure.

Why Glaucoma Is the “Sneak Thief of Sight”

Open-angle glaucoma, often called the “sneak thief of sight,” rarely causes symptoms in the early stages of the disease. The loss of vision from open-angle glaucoma typically starts from the peripheral visual field, or “side vision,” which means it is often unnoticeable. It’s only in the moderate stages of the disease that these side vision deficits become more noticeable. Even then, some patients do not notice the symptoms and if one eye is more affected by glaucoma than the other, the healthier eye compensates, which makes changes less noticeable.

Only in the late stages of glaucoma is the central vision affected, which means many patients with advanced glaucoma still have 20/20 vision in the center. The lack of symptoms helps explain why an estimated 50 percent of the 3 million Americans with glaucoma don’t even know they have it. The lack of symptoms is also why the National Eye Institute and the American Academy of Ophthalmology recommend all adults age 40 or older have a dilated eye exam so glaucoma can be detected early before vision loss occurs.

Apps for People with Low Vision

Apps (short for applications) on mobile devices have an important place in the list of assistive devices for the visually impaired. While the technology can be expensive, it may be comparable to, or a better investment than, assistive technologies that are only able to perform one or two functions. A few of the newest innovations include:

VoiceOver: Apple’s gesture-based screen reading software allows users to navigate iPhone screens and enjoy the touch features that a sighted user would. Users hear descriptions of what’s on the screen - everything from the menu options to facial expressions of people in photos.

Seeing AI: Microsoft’s easy-to-use, free app acts as a talking camera using AI (artificial intelligence) to describe people, text, and objects. The app can function as a document reader, currency identifier, barcode scanner, light detector, short text reader, and even a handwriting reader.

Be My Eyes: This free app pairs a visually impaired person with a sighted volunteer via video chat within a minute to assist with simple tasks, such as adjusting the thermostat.

To learn more visit: brightfocus.org/glaucoma-apps

Clinical Research Study Underway to Save Sight from Glaucoma

A clinical research study supported by National Glaucoma Research, a BrightFocus Foundation program, will test promising new concepts to protect vision and develop new vision treatments.

Linda Zangwill, PhD, a current National Glaucoma Research grantee at the University of California, San Diego, has designed a clinical study that uses advanced imaging technology to improve our understanding of the complex relationship between structural and functional change over time in the aging and glaucoma eye.

Current treatments available for glaucoma are based on lowering of intraocular pressure (IOP). This study will provide new information that will help the development of new therapies that are a “non-IOP lowering” approach for glaucoma. According to Dr. Zangwill, “I hope to develop techniques to improve glaucomatous change detection and identifying risk factors that can predict rapidly progressing glaucoma.”

To receive a free copy of “Clinical Trials: Your Questions Answered,” and learn how you can participate in clinical research, visit brightfocus.org/GlaucomaTrials or call 855-345-6647.

This is the latest in a series of articles promoting awareness of clinical trials that is supported in part by an educational sponsorship from Biogen. BrightFocus is solely responsible for the content of the article.

Italian Soup

Studies suggest that eating green leafy vegetables decreases the risk of glaucoma.

Ingredients

  • 1- 19 ounce can cannellini beans
  • 1 1/2 tablespoons extra virgin olive oil, divided
  • 1/2 medium onion, halved and sliced
  • 2 cups Savoy cabbage
  • 1 1/2 cloves garlic, minced, plus 1/2 garlic clove
  • 2 2/3 cups reduced-sodium chicken or vegetable broth
  • Freshly ground pepper to taste
  • 4 - 1/2 inch thick slices day-old whole-wheat country bread
  • 1/2 cup grated fontina or Parmesan cheese

Directions

  1. Mash 3/4 cup of beans with a fork.
  2. Heat 1 teaspoon oil over medium heat in a Dutch oven or soup pot. Add onion and cook, stirring often, until softened and lightly browned, 2 to 3 minutes. Add cabbage and minced garlic; cook, stirring often, until the cabbage has wilted, 2 to 3 minutes. Add broth, mashed beans and whole beans; bring to a simmer. Reduce heat to medium-low, partially cover and simmer until the cabbage is tender, 10 to 12 minutes. Season with pepper.
  3. Shortly before the soup is ready, toast bread lightly and rub with the cut side of the garlic clove (lightly or heavily depending on taste). Divide toast among 4 soup plates. Ladle soup over the toast and sprinkle with cheese. Drizzle about 1 teaspoon oil over each serving. Serve immediately.

Tips

To Make Ahead: Prepare through Step 2. Cover and refrigerate for up to 2 days. Reheat on the stovetop.

Makes 4 servings.

Create a Legacy with our Heritage Society

Heritage Society donors express their commitment to National Glaucoma Research through a very special and important form of financial support. By naming National Glaucoma Research as the beneficiary of a planned gift, such as an estate gift, life insurance policy, or other financial asset, Heritage Society members make a lasting contribution to support research that will help millions of people affected by glaucoma.

Through these legacy gifts, donors make a profound impact on the future of glaucoma research. For more information please call Charles Thomas at 1-301-556-9397 or visit www.brightfocusplannedgiving.org/.

Tips for Using Your Other Senses

Most people with low vision are surprised to find out how much information they can gather from their senses of hearing, touch, and even smell. Paying special attention during specific activities may help you develop the use of your other senses and enhance your quality of life.

  • Listening to books, newspapers, and magazines through audio devices will help develop your ability to retain information you’ve heard.
  • Tuning in to specific environmental noises, such as the hum of the refrigerator or sounds from an open window, will assist with location detection.
  • Learning the texture of fabrics in your wardrobe and associating them with a mental image of the garment will make selecting clothes from the closet easier.
  • Using a cane or walker outdoors can help detect changes in pavement, the closeness of objects or the presence of stairs, helping to prevent dangerous falls.

For more tips, visit brightfocus.org/NGR.

Medications That May Affect Glaucoma

I f you have angle closure or open angle closure glaucoma, there are medications that can adversely affect you or put you at risk for developing glaucoma. Below are examples that may apply, categorized by condition. Call your ophthalmologist prior to using any medication that has a glaucoma warning.

Asthma and COPD Medications
Atrovent® or Spiriva®

Incontinence and Overactive Bladder Medications
Detrol® and Ditropan®

Gastrointestinal Issues
Tagamet® and Zantac®

Muscle Spasms
Norflex® and Artane®

Depression
Prozac® and Paxil®
Elavil® and Tofranil®

Allergies
Anti-allergy over-the-counter drugs containing diphenhydramine

Nausea
Phenergan®

Anxiety
Vistaril®

Cold Remedies
Medications containing ephedrine can result in acute angle-closure glaucoma attacks in patients with preexisting narrow angles.

Oral steroids
Used for many conditions including autoimmune diseases (lupus, autoimmune hepatitis), inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), joint and muscle diseases (rheumatoid arthritis, polymyalgia rheumatic), and allergies and asthma.

Learn more about glaucoma at brightfocus.org/NGR.